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A big part of therapy is learning some of the ways that humans protect themselves neurobiologically.
This can help us to better understand what we're experiencing in our bodies when our minds feel anxious, depressed, enraged or frightened. It can help us to effectively regulate those feelings.
Below are just a few words on some of the concepts and terms that you will likely encounter on your therapy path.
For the sake of brevity, I will often use the shorthand term ‘nervous system’ to discuss the functions of the Autonomic Nervous System (ANS). The ANS is fully involved with our moment to moment feelings of safety and danger and lead to the undesirable sensations and behaviors, even physical pain, that most frequently bring clients to therapy.
The feelings of anxiety, depression, panic, addiction, grief, despair and so on, can be so awful that they can feel akin to physical pain. This physical discomfort produced by the ANS can become so extreme, so agonizing, that daily life starts to feel truly unbearable.
Addressing the ANS, understanding it, and developing skills for self-regulation will be one of the first tasks that we undertake together to bring some immediate relief for this kind of daily agony.
The ‘parts of consciousness’ or ‘parts of the personality’ is a concept that comes up often in therapy and refers to the natural division of labor in the brain and the parts of one's ego that become associated with given tasks. All people frequently experiences 'inner dialogues' among these parts. This is not the same thing as 'multiple personality' or 'Dissociative Identity Disorder.
Internal Family Systems (IFS) is one of the better known modalities for addressing internal psychic conflicts; although, working with more elaborated or dissociated parts that are connected with complex traumas will likely require a more robust approach than what IFS can offer alone. Concepts from ego-state psychology are also valuable for this work.
The attachment system functions primarily to drive baby mammals (including humans) to maintain close proximity to mother for food, warmth, protection, etc, in the interests of survival. The real-time relationship of the mother and child that unfolds in the first stages of life will then form attachment patterns and styles in the child that will serve as templates/models for all their future relationships.
When those attachment patterns are formed under distress (neglect/abuse/trauma), people will frequently develop problematic attachment styles that can operate throughout one’s lifetime.
Despite the tremendous force of attachment system in people’s lives, it is a system that functions largely at the instinctive and subconscious level, without a person’s full awareness. Work with the attachment system is valuable even when one’s current issues may seem completely unrelated because the attachment system will play a role in how one seeks safety or avoid danger in all situations and relationships.
We find the word ‘trauma’ used quite heavily across the culture with varying intentions and meanings. This makes it difficult at times to understand what is being communicated when the term is used.
My working concept for Trauma (and the language I use for it) is derived primarily from the literatures of psychology and neuroscience and is aligned with the trauma reprocessing work that one finds in EMDR.
Put in basic terms: The word ‘trauma’ can be used to indicate the presence of memories that have not been fully processed neurologically. These unresolved memories are stored as if they are still occurring in the present, which keeps the brain actively seeking signs of returning danger. These signs (sounds, smells, tastes, images, etc.) are often called “triggers,” which put the entire nervous system on alert. And these reactions are often described as “being triggered,” by those who are experiencing them.
(Eye Movement Desensitization and Reprocessing)
There are many excellent sources for learning about EMDR. This is just a thumbnail sketch for quick reference. EMDR is a technique that attempts to activate the mind’s natural ability to process its own experiences and to heal itself. This natural ability to heal oneself is common to all humans, without exception. It allows a person to adapt to changing (and sometimes highly distressing) environments, and ultimately to repair itself after potentially traumatizing events.
This natural process of the mind is akin to the body’s ability to repair itself physically (cuts, tears, broken bones, etc.). Sometimes, however, a wound is too big for the body to handle on its own. For example, when a cut is too deep, we use stitches to help the body complete the repair. The stitches don’t do any actual healing work on their own—the body does that—they merely create the conditions for the body to do what it naturally wants to do.
This is analogous to the mind’s adaptive information processor (AIP) and EMDR can be likened to the stitches. As with the body, sometimes events can override mental defenses and overwhelm the mind's natural ability to heal. When that happens, like the deep cut that needs the help of stitches, this deep psychological wound needs an outside intervention.
Similar to the stitches, EMDR isn’t doing anything to the client, it's not doing any actual healing work outside of the client's own will; EMDR enables the client to do the healing themselves. What the EMDR process and therapist are doing, for the most part, is creating and holding the optimal conditions for the client while the client does their own work internally. Clients who choose to undergo EMDR therapy will be given much more information about the process and coached through relevant skills prior to treatment beginning. Safety must be a priority in this work; without safety, the mind will simply not allow reprocessing to occur.
Adaptive Resolution is a term that one finds in the Psychology tradition and specifically within EMDR literature. Adaptive Resolution refers simply to the mind’s natural ability to sift through the details of an experience, however unpleasant or harrowing, find whatever information or skills that might be usable for future living and survival, and discard the rest.
People experience this type of reprocessing daily when they dream. As the mind combs through the details of a day, it takes what information can be adapted for future use and essentially deletes the rest. What emerges to consciousness from a dream can be thought of as the byproducts of that process. The byproducts are not inherently meaningful but they may offer clues into what the mind has been working through.
Once the mind has achieved adaptive resolution for a given memory, that memory is no longer coded as occurring in the present. It no longer feels as if it is happening right now. The experience can then be disconnected from the autonomic nervous system. It is the involvement of the nervous system that makes these memories so “triggering” and painful to experience over and again. When the memory is coded as “over” or completed, the mind can recall the experience without distress because it is now understood, even at the subconscious level, that the danger is no longer present.
This is simply an analogy for the way we approach unresolved and often heavily defended memories. In traditional 'talk therapy' a client and therapist will approach these memories together through conversation. The client works verbally through the experience with the therapist, and together they hope to find some resolution.
In EMDR, a client approaches their memories internally without speaking. It might be thought of as something like rapelling downward into the darkness of one's subconscious. The therapist does not go too, they cannot go too, because the experience is happening inside the client's mind and there are no words.
The client's main job during reprocessing is to maintain mental proximity to the distressing memory while their own Adaptive Information Processer (AIP), their own mind, works through the material to complete what it never had a chance to do when the experience first occurred. This is adaptive resolution.
In between these brief (about one minute) 'sets' of reprocessing, the client will give one line summaries of what they just saw or felt as the healing work progresses.
The therapist's main job during reprocessing is to 'hold' the client energetically in safety to allow their minds to comfortably process some very difficult material that has been locked away in their subconscious, oftentimes for many years, if not decades. Periodically, the client will find their process becomes 'stuck' (no longer progressing) and in these situations, the therapist will offer suggestions for the next set. A therapist can do that, they can suggest, but they cannot actually join in the moment of reprocessing. Ultimately, it will always be the client who does their own healing work in EMDR.
This is what I value most about EMDR *
Is EMDR the end of treatment?
There are occasions in which the EMDR protocol is used to bring an acute event (usually a single traumatic experience) to adaptive resolution. In these cases, a client might experience full relief from the symptoms of PTSD almost immediately after completing treatment.
More frequently, however, with chronic and complex PTSD, EMDR will not represent the final stage of treatment. In these cases, clients can indeed expect to find all the old 'triggers' from their traumatic experiences abruptly gone. This can lead to the mistaken impression that the work is done.
It must be understood that one's mind has been operating under the conditions of PTSD for a long time, possibly a lifetime, and one's entire way of being and relating has been heavily influenced by the pressures of an overactivated nervous system.
Once these 'triggers' have been let go of, clients find themselves on a new, and wonderful, and somewhat daunting frontier within themselves. Things that could never be done or said before can be done and said without an internal attack from the nervous system. That opens vast possibilities and opportunities for growth. And yet, the mind is sometimes so habituated to being defensive, it does not always recognize that the dangers are gone and that a new way is possible. This is the work we begin after EMDR.
* tyler boudreau is a Certified EMDR therapist through EMDR International Association (EMDRIA) and is trained in both traditional and intensive formats of the EMDR protocol.
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